Renal functional and surgical outcomes after robot-assisted partial nephrectomy for hilar vs non-hilar tumors: Trifecta and pentafecta evaluation

doi:10.5527/wjn.119576

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World Journal of Nephrology

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2220-6124

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Nephrol. Sep 25, 2026; 15(3): 119576
Published online Sep 25, 2026. doi: 10.5527/wjn.119576

Table 1 Patient characteristics, n (%)/median (interquartile range)

Characteristics		Entire cohort				Propensity matched cohort
Characteristics		Entire cohort, n = 324	Hilar tumor, n = 60	Non-hilar tumor, n = 264	P value	Hilar tumor, n = 60	Non-hilar tumor, n = 60	P value	SMD
Age (years)		66 (28-92)	66 (39-85)	66 (28-92)	0.909	66 (39-85)	66 (37-92)	0.956	0.011
Sex (%)	Male	230 (71.0)	44 (73.3)	186 (70.5)	0.753	44 (73.3)	41 (68.3)	0.688	0.110
BMI (kg/m²)		24.0 (14-45.2)	23.9 (17.3-35.3)	24 (14-45.2)	0.949	23.9 (17.3-35.3)	23.6 (15.7-32.6)	0.103	0.322
ECOG-PS (%)	0	279 (86.1)	54 (90)	225 (85.2)	0.616	54 (90)	54 (90.0)	1	< 0.001
	1	44 (13.6)	6 (10)	38 (14.4)		6 (10)	6 (10.0)
	2	1 (0.3)	0	1 (0.4)		0	0
Comorbidity (%)	Diabetes mellitus	85 (26.2)	17 (28.3)	68 (25.8)	0.745	17 (28.3)	43 (71.7)	1	< 0.001
	Hypertension	147 (45.4)	29 (48.3)	118 (44.7)	0.667	29 (48.3)	17 (28.3)
Laterality (%)	Right	177 (54.6)	34 (56.7)	143 (54.2)	0.775	34 (56.7)	31 (51.7)	0.714	0.100
	Left	147 (45.4)	26 (43.3)	121 (45.8)		26 (43.3)	29 (48.3)
Preoperative estimated glomerular filtration rate (mL/minute/1.73 m²)		70.0 (17.9-115.2)	71 (22.7-96.3)	69.6 (17.9-115.2)	0.920	71 (22.7-96.3)	68.6 (25.4-100.1)	0.902	0.017
Preoperative CKD staging (%)¹	I	26 (8.0)	2 (3.3)	24 (9.1)	0.516	2 (3.3)	6 (10.0)	0.402	0.324
	II	197 (60.8)	39 (65.0)	158 (59.8)		39 (65.0)	33 (55.0)
	III	91 (28.1)	17 (28.3)	74 (28.0)		17 (28.3)	20 (33.3)
	IV	10 (3.1)	2 (3.3)	8 (3.0)		2 (3.3)	1 (1.7)
Tumor size (mm)		3.1 (11-69)	3.3 (10-69)	3.0 (11-68)	0.134	3.3 (10-69)	3.4 (1.2-5.8)	0.994	0.007
Medical device (%)	DaVinci	319 (98.5)	59 (98.3)	260 (98.5)	1	59 (98.3)	59 (98.3)	1	< 0.001
	Hinotori	5 (1.5)	1 (1.7)	4 (1.5)		1 (1.7)	1 (1.7)
Approach (%)	Intra	199 (61.4)	33 (55.0)	166 (62.9)	0.304	33 (55.0)	34 (56.7)	1	0.034
Surgeon’s experience (cases > 20) (%)	≥ 20	216 (66.7)	45 (75.0)	171 (64.8)	0.172	45 (75.0)	42 (70.0)	0.683	0.112
R score (%)¹	1	236 (72.8)	44 (73.3)	192 (72.7)	1	44 (73.3)	39 (65.0)	0.429	0.181
	2	88 (27.2)	16 (26.7)	72 (27.3)		16 (26.7)	21 (35)
E score (%)	1	115 (35.5)	15 (25.0)	100 (37.9)	0.105	15 (25.0)	16 (26.7)	0.893	0.102
	2	142 (43.8)	28 (46.7)	114 (43.2)		28 (46.7)	25 (41.5)
	3	67 (20.7)	17 (28.3)	50 (18.9)		17 (28.3)	19 (31.7)
N score (%)	1	36 (11.7)	2 (3.3)	34 (12.9)	0.047^b	2 (3.3)	2 (3.3)	0.915	0.104
	2	55 (17.0)	8 (13.3)	47 (17.8)		8 (13.3)	6 (10.0)
	3	233 (71.9)	50 (83.3)	183 (69.3)		50 (83.3)	52 (86.7)
A score (%)¹	A	75	29 (48.3)	109 (41.3)	0.569	29 (48.3)	29 (48.3)	0.720	0.149
	P	111	20 (33.3)	92 (34.8)		20 (33.3)	20 (33.3)
	X	148	11 (18.3)	63 (23.9)		11 (18.3)	11 (18.3)
L score (%)	1	102	0	102 (38.6)	< 0.001^c	0	0	1	0.036
	2	93	18 (30.0)	75 (28.4)		18 (30.0)	19 (31.7)
	3	129	42 (70.0)	87 (33.0)		42 (70.0)	41 (68.3)
Renal score (%)¹	4	9 (2.8)	9 (3.4)	0	< 0.001^c	0	0	0.574	0.432
	5	27 (8.3)	2 (3.3)	25 (9.5)		2 (3.3)	1 (1.7)
	6	37 (11.4)	0 (0)	37 (14.0)		0 (0)	3 (5.0)
	7	56 (17.3)	4 (6.7)	52 (19.7)		4 (6.7)	2 (3.3)
	8	64 (19.8)	13 (21.7)	51 (19.3)		13 (21.7)	12 (20.0)
	9	79 (24.4)	24 (40.0)	55 (20.8)		24 (40.0)	21 (35.0)
	10	47 (14.5)	16 (26.7)	31 (11.7)		16 (26.7)	18 (30.0)
	11	5 (1.5)	1 (1.7)	5 (1.5)		1 (1.7)	3 (5.0)

^bP < 0.01.

^cP < 0.001.

¹Propensity unmatched.

SMD: Standardized mean difference; BMI: Body mass index; ECOG-PS: Eastern Cooperative Oncology Group Performance Status, CKD: Chronic kidney disease.

Full Size Table

Table 2 Univariate and multivariate analyses of factors predicting trifecta achievement

	Univariate analysis			Multivariate analysis
	OR	95%CI	P value	OR	95%CI	P value
Age ≥ 66	0.697	0.442-1.10	0.122
Male	0.940	0.569-1.55	0.810
BMI ≥ 24	0.671	0.425-1.06	0.087
ECOG-PS ≥ 1	0.636	0.335-1.21	0.167
Diabetes mellitus	0.798	0.48-1.33	0.385
Hypertension	0.855	0.542-1.35	0498
Preoperative CKD stage ≥ 3	0.558	0.345-0.905	0.018	0.578	0.354-0.942	0.028^a
Surgeon’s experience ≥ 20 cases	1.270	0.788-2.05	0.327
R score ≥ 2	0.478	0.29-0.788	0.004^b	0.492	0.297-0.814	0.006^b
E score ≥ 3	0.864	0.497-1.50	0.606
N score ≥ 3	0.624	0.369-1.06	0.079
L score ≥ 3	0.782	0.493-1.24	0.297
Intra approach	1.01	0.633-1.61	0.974
Hilar tumor	1.03	0.575-1.84	0.921	0.965	0.534-1.75	0.907
RENAL score ≥ 10	0.666	0.356-1.22	0.185

^aP < 0.05.

^bP < 0.01.

OR: Odds ratio; CI: Confidence interval; BMI: Body mass index; ECOG-PS: Eastern Cooperative Oncology Group Performance Status, CKD: Chronic kidney disease.

Full Size Table

Table 3 Univariate and multivariate analysis of factors predicting pentafecta achievement

	Univariate analysis			Multivariate analysis
	OR	95%CI	P value	OR	95%CI	P value
Age ≥ 66	0.886	0.482-1.63	0.697
Male	0.534	0.285-1.00	0.051
BMI ≥ 24	0.560	0.301-1.04	0.067
ECOG-PS ≥ 1	1.07	0.448-2.56	0.876
Diabetes mellitus	0.589	0.273-1.270	0.178
Hypertension	0.657	0.351-1.230	0.190
Preoperative CKD stage ≥ 3	0.864	0.442-1.690	0.670
Surgeon’s experience ≥ 20 cases	2.5	1.160-5.37	0.019^a	3.73	1.64-8.49	0.002^b
R score ≥ 2	0.328	0.135-0.802	0.015^a	0.319	0.125-0.810	0.016^a
E score ≥ 3	0.490	0.199-1.2	0.120
N score ≥ 3	0.455	0.243-0.853	0.014^a	0.449	0.224-0.898	0.024^a
L score ≥ 3	0.438	0.219-0.876	0.020^a	0.306	0.138-0.681	0.004^b
Intra approach	1.50	0.814-2.770	0.194
Hilar tumor	0.652	0.317-1.34	0.245	2.61	1.12-6.08	0.026
RENAL score ≥ 10	0.0915	0.0123-0.678	0.019^a

^aP < 0.05.

^bP < 0.01.

OR: Odds ratio; CI: Confidence interval; BMI: Body mass index; ECOG-PS: Eastern Cooperative Oncology Group Performance Status; CKD: Chronic kidney disease.

Full Size Table

Citation: Hara T, Suzuki K, Wakita N, Okamura Y, Ueki H, Bando Y, Terakawa T, Hyodo Y, Chiba K, Teishima J, Yao A, Miyake H. Renal functional and surgical outcomes after robot-assisted partial nephrectomy for hilar vs non-hilar tumors: Trifecta and pentafecta evaluation. World J Nephrol 2026; 15(3): 119576
URL: https://www.wjgnet.com/2220-6124/full/v15/i3/119576.htm
DOI: https://dx.doi.org/10.5527/wjn.119576

Hara T, Suzuki K, Wakita N, Okamura Y, Ueki H, Bando Y, Terakawa T, Hyodo Y, Chiba K, Teishima J, Yao A, Miyake H. Renal functional and surgical outcomes after robot-assisted partial nephrectomy for hilar vs non-hilar tumors: Trifecta and pentafecta evaluation. World J Nephrol 2026; 15(3): 119576 [DOI: 10.5527/wjn.119576]

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